Primary Care Mental Health Service Carmarthenshire
Judith Evan-Jones Team Manager Liza Evans PCMH Practitioner Sylvia Smith Course Participant Population of Carmarthenshire
Total pop :172,842 Concentrated pop: -Llanelli 23,435 -Carmarthen 13,148 -Pembrey/Burry Port 7,952 -Ammanford 5,299 -Llangennech 4,509
Leaving a rural population of 118,499 Issues with previous service provision?
Long waiting times Seen late in the ‘journey’ No choice Little joined up working with voluntary organisations Neglect of social factors Tip of the iceberg Poor outcomes High rates of referral ‘learned helplessness’? Primary Care Mental Health
90% of people with mental health problems are only seen in primary care services
1 in 4 people will suffer with their mental health in any one year
Primary care needs are very different from secondary care needs
Primary care skills are very different from secondary care skills
In view of this the traditional model of service delivery would be unsustainable PCMHT Goals
to raise awareness to be proactive – prevent or intervene early to empower users / offer genuine choice to support service users to take responsibility for their own health increasing resilience and coping strategies to combine the psycho and the social multiple points of access be one primary care mental health service to become more efficient and more effective So, a radically new model not just more of the same Emphasis on
very high volume, easy and quick access, no waiting lists, easy to return to service
no extra demands on GPs, self-referral
skill-sharing/working with others
multi-level
‘stepped care’? PCMHT Carmarthenshire
1 Team Manager / Development Officer
2 Qualified Mental Health Practitioners
Contract with the Carmarthenshire Counselling Service to provide a Brief Interventions Service DepressionDepression SocialSocial AngerAnger problemsproblems
HealthHealth DrinkDrink problemsproblems problemsproblems STRESSSTRESS
Self-confidenceSelf-confidence SleepSleep SelfSelf esteem esteem problemsproblems
AnxietyAnxiety PanicPanic The PCMHT Model Based on The Glasgow Model
Indiv tx
Groups
Assessment / screening
Self help materials
Working with others
Population level Awareness raising; community involvement; early intervention/prevention Indiv tx
Groups
Screening and assessment
Non face-to-face work
Working with others
Population level Awareness raising; community involvement; early intervention/prevention Indiv tx Individual Interventions Groups Assess/screen
Non-face-to-face interventions
Working with others
Awareness raising/community involvement/outreach Brief Intervention Service provided by Carmarthenshire Counselling Service
6 sessions
Therapeutic approaches offered: -Person-Centred Counselling - Adlerian Counselling -Solution Focused Therapy -Cognitive Behavioural Therapy (CBT) -TA interventions Referrals to Counselling Service
2010 No of ref. GP ref Self ref
Jan 81 51 30 Feb 92 54 38 March 117 55 62 April 74 30 46 May 78 44 37 June 78 41 37 Total 520 325 250 Ind tx
Groups
Assessment / screening
Non face-to-face work
Working with others
Population level Awareness raising; community involvement; early intervention/prevention ‘Stress Control’
7 session CBT (evenings and lunchtimes) No discussion of personal problems Community venue, rolling programme Self referral Partners/friends encouraged to attend Large numbers attend often up to 100 High demand, normalising (men) Stress Control
From January to June 2010
14 courses in Llanelli, Carmarthen, Llandovery, Ammanford and Llandeilo
520 people completed Anxiety
8.0% Improved HADS 6.5% score Increased HADS score HADS score same
85.5% n=180 Depression
13.4% Improved HADS score Increased HADS 10.6% score HADS score same
76.0%
n=180 Stress Control Challenges
Change in culture
Suitable venues
Record keeping
Access problems (rural and deprived) New Groups for the future
Mood Matters Social Confidence Mind Gym Mindfulness Living Life to the Full Indiv tx
Groups
Assessment and Screening
Self Help Materials
Working with others
Population level Awareness raising; community involvement; early intervention/prevention Assessment and Screening
Informal phone screening Counselling service assessment HADS scores before and after stress control courses Indiv tx
Groups
Single contacts
Self Help Materials
Working with others
Population level Awareness raising; community involvement; early intervention/prevention Bibliotherapy / Book Prescription Wales Computerised CBT
GPs (and others) prescribe from a list
Alternative to anti-depressants?
Healthy Reading
All libraries in Wales
Empowering
Livinglifetothefull.com Indiv tx
Groups
Single contacts
Non face-to-face work
Working with others
Population level Awareness raising; community involvement; early intervention/prevention Indiv tx
Working with others Groups
Assessment
Non-face-to-face interventions Working with others Awareness raising/community involvement/outreach
Promoting recovery as opposed to cure models
Training for primary Care Staff
Mental Health First Aid Training
Pharmacy, vitality scheme, Artscare,Samaritans Indiv tx Mental health first Aid Groups Single contacts
Non-face-to-face interventions Working with others Awareness raising/community involvement/outreach Raising awareness and understanding
Skill sharing
Increasing confidence
Improving pathways for service users
Links with Suicide and Self Harm Reduction Action Plans
Tackles stigma Mental Health First Aid
9 courses run in the last year
2 day course
216 people attended
acute nurses, voluntary sector, Local Authority staff, Condition Management Team, Chronic Disease Management nurses, youth nurses, Public Health staff
Excellent Feedback
2 days too difficult for primary care and ward staff Indiv tx
Groups
Single contacts
Non face-to-face work
Working with others
Population level Awareness raising; community involvement; early intervention/prevention Indiv tx Population level Groups Assessment
Non-face-to-face interventions
Working with others Mental Health Promotion Events Awareness raising
Advice and information in local libraries
Supermarkets
Leaflet drops in shops and cafes
Town centres
Local livestock markets
Radio, newpaper, TV Referrals to the service from January to June 2010
937 advice/ information / stress control phone contact
1,040 referrals What have we learned?
PC needs are never ending
Excellent outcomes with limited resource
Huge potential with increased budget
Motivated, enthusiastic committed staff
Deprivation plays a huge role (recession)
Rural areas need more assertive approach
It’s not rocket science: so many things we can do
General public keen to discuss mental health issues
Everybody knows someone who has a mental health issue
We have a lot more skills than we thought STRESS CONTROL Overview how stress control works
How well its done so far
Down sides
Future Setting the scene
What is stress control Where does it come from Who does it help Who cant it help Is it easy to get to Does it work Who teaches stress control How does it fit in with the other choices available Treating anxiety and Stress
A Group Psycho-educational Approach Using CBT principles (Cognitive Behavioural Therapy) Dr Jim White, Consultant Clinical Psychologist from Glasgow
www.glasgowsteps.co.uk For people over the age of 16 who are experiencing stress or related problems
Not for people already receiving a service from secondary care
Courses held in local venues evenings and afternoons
Empirical testing is very positive up to 85% effective so it does work Stress Control is a robust 7 session “evening Class” designed for small or large groups 6 - 60 people
The goal is to “turn people into their own therapists”
Empirically tested, clinically tested, and efficient Courses are run by qualified mental health practitioners
Just one of the choices available Content of stress control
Wk 1 Introduction and information Wk 2 Controlling your body Wk 3 Controlling your thoughts Wk 4 Controlling your actions (Exercise) Wk 5 Controlling your panic (Mood and Food) Controlling your sleep ( Pharmacist) Wk 6 Controlling your depression Wk 7 Controlling your future Tying it all together The Down side
Access to the best venues (Rural County)
Evening working
Administration time
DNA rate Participant comments
What were the most helpful things about the programme?
“The Knowledge that I am not going mad & there are things I can do to help myself”
“ Easy approach and the information was broken down into easy to understand bite size modules” What were the most/least helpful things about the programme?
“It helped me realise what was depression and what was anxiety”
“It was just great , literature, presentation, speaker made me feel really comfortable and at ease”
“The Stress pack meant I could show those close to me how I felt. Learning about vitality Course was very helpful. Being able to talk and write things down and ask questions made things much easier to cope with.” What may help you to continue to put into practise what you have learned on the programme?
I would come back because I think I need the support, still not a hundred percent but much better than I was”
“Meeting people of similar conditions”
“Gaining knowledge to empower myself”
“Going to the Gym”
“May return for further sessions” The Future of Stress Control
We need to continue the rolling programme which is established in Carmarthen and Llanelli.
We have to continue with smaller courses in rural districts
We need to continue to listen to the needs of participants and offer flexible solutions
We need to publicise and promote
We need to build trust with the community and challenge stigma in all areas. Stress Control Training
A Patient Story Life Before Stress Control Training…
“I had fallen apart. I wasn’t coping with anything. “I can’t do it”. I’d given up my job. I just couldn’t cope “No-one ever to help me”. with that anymore”
A friend recognised the symptoms… GP Appointment “I don’t want anti-depressants – “been there” there’s nothing wrong with me.”
Go to see your GP ! GP - Try Stress Control Training – here’s the telephone number Attending the First Session
Nervous “Don’t know where it is” “What if I see someone I know” “Do I really want to go in?” “What am I letting myself in for? “How can I escape?” “And of course it was either Alison or Liza who said come on in – don’t be afraid, sit by the door and if you want to go at half time you go.”
“It was so reassuring”
“They took the time” Experience of the Course
Techniques
You learn breathing techniques Impact to be used every morning and evening “By the time I was getting to the end of it I was feeling a lot better.” What was taught made a difference
Resources Opportunity to repeat the course The CD – is fantastic “I had to go and buy a personal “You learn something CD player so I could different every time” take it with me” Has it made a difference? Achievements so far…
Stress control training I cannot believe it, in practice I have learned to swim
Just relax Deep breaths Distraction
“You won’t believe what I have done I’ve overcome a lifetime fear” Reducing anxiety, planning skills “I went to the Chiropodist. “Driven all the way to Kent” I cant stand anyone touching my feet”
“I did it I did it!” The future…
Not everyday is fantastic Living Life “I was not having a good day but I have got to go {chiropodist} Determined to go out and live my life and by the time I got home “when I get home I feel I felt a hundred times better” absolutely exhausted but I feel as if I’ve achieved something”
Making the effort Coping
“I know its not doing me any good A very difficult life event came sitting at home and forcing it up in November {to go out}. Since stress control its so much easier “Without Stress control I know I make my plan before I go”. I would not have coped with it” A long and winding road…
Blips along the way
I had a ripple last February with the snow and ice and disruption But……. In November it was a tidal wave
“I need someone to remind me “I couldn’t see what I had every now and then of achieved. I needed someone what I have done because to remind me. I get too much time on my own.” It felt like more than just a blip” Personal Goals…
Looking for work
“I really feel I need to find some structure to my life” I am ready for my next challenge What ever that may be “I’ve been for an interview.” …. Couldn’t have imagined doing this a year ago Comments on the course
Feedback to the GP
“Its marvellous, wonderful, send everyone.”
Personal Recommendations Invitation to a friend
“took the CD and book and passed it on” “come with me” Thank You
Judith Evan-Jones RMN, Dip Couns, BSc Hons [email protected] 01269 833369
Liza Evans RMN [email protected]
Sylvia Smith Course Participant